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* 1. What school are you affiliated with and grade do you teach?

  Pre K Kindergarten 1st grade 2nd grade 3rd grade 4th grade 5th grade 6th grade 7th grade 8th grade Other
Cotaco School
Danville-Neel Elementary
Eva School
Falkville Elementary
Lacey's Spring School
Priceville Elementary
Sparkman School
Union Hill School
West Morgan Elementary

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* 2. Have you referred a child/children to the FACT program?

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* 3. Which referral service was requested for the child or children?  Check all that apply.

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* 4. Did the child/children receive the assistance for which they were referred?

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* 5. Did you notice a change in the child/children's classroom performance after the referral?

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* 6. Did you notice an improvement in parental involvement after you referred a child/children to FACT?

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* 7. Did the FACT program staff respond to the referral in a professional manner?

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* 8. Did the FACT program staff respond to the referral in a timely manner (within one week of the referral)?

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* 9. Do you feel the FACT program has been helpful to you as an educator?

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* 10. Do you feel the FACT program and its services improved your classroom environment?

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* 11. Additional Comments:

T